Effective Chronic Pain Management

On this blog you will see Dr. Stephen Grinstead's frequent tips, news and information related to chronic pain management and other coexisting problems. To learn more go to his website at www.addiction-free.com.

Tuesday, October 26, 2010

Whenever you are experiencing pain, it’s helpful to ask: What is my pain trying to tell me? Pain is the signal that says something is wrong; that you need to find out what is it, and then learn how to manage it. Sometimes it can be difficult if not impossible to pinpoint the pain generator, and as human beings we want to know why something is happening and we want to know “right now.” But when we’re in pain the more important question is: What can I do, right now, to manage my pain in a healthy way that supports me physically, emotionally and spiritually? The answer will be different for each person.

But what if you can’t answer that question because your chronic pain has become unmanageable, no matter what you try? This brings us to a discussion of pain versus suffering. The psychological meaning that you assign to a physical pain signal will determine whether you simply feel pain (Ouch, this hurts!) or experience suffering (This pain is awful and will just keep getting worse; this is terrible and why is it happening to me!). Although pain and suffering are often used interchangeably, there is an important distinction that needs to be made. Pain is a physical sensation, a warning signal telling you that something is going on in your body. Suffering results from the meaning or interpretation your brain assigns to the pain signal.

Many people believe that: I shouldn’t have pain! Or Because I have pain and I’m having trouble managing my pain, there must be something wrong with me. A big step toward effective chronic pain management occurs when you can reduce your level of suffering by identifying and changing your thinking and beliefs about your pain, which in turn can decrease your stress and overall suffering. Because of the two parts—pain and suffering—chronic pain management must also have two components: physical and psychological. The way you sense or experience pain—its intensity and duration—will affect how well you are able to manage it.

To learn more about how to effectively address chronic pain and suffering please check out my article Pain Versus Suffering in Chronic Pain Management that you can download for free on our Article page.

If you'd like to receive training for helping people with chronic pain and coexisting disorders, including addiction, I'm very excited to announce we are once again presenting my Addiction-Free Pain Management® Certification Training in Sacramento on November 11-13, 2010 this time in our new office space. To learn more about this and my other upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you're in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Thursday, September 30, 2010

Not everyone with chronic pain and depression will need antidepressant medications. However, this class of medication may be indicated for several reasons; one is that many people living with chronic pain disorders become clinically depressed. The Addiction-Free Pain Management® System suggests a full biopsychosocial evaluation to determine the severity of the problem before any medications are prescribed.

Situational depression responds best to cognitive behavioral therapy and in those cases medications are not necessary. Other types (bipolar) may need a medical intervention in addition to psychotherapy. There are many different types or classifications of antidepressants to choose from, therefore a specialist should be consulted to determine the most effective medication for each person.

Pain reduction is another key factor to consider using an antidepressant. For example the use of tricyclic antidepressants has been an effective tool in pain management for years. The tricyclic medication Elavil (amitriptyline) is frequently used to treat and help prevent migraine headaches. These antidepressants have been able to provide relief for nerve pain and often result in lowering the dose of opiate medications. Since sleep disturbances often accompany both chronic pain and depression some healthcare providers use this type of medication as a sleep aid.

Another class of newer antidepressants is the SSRIs (selective serotonin reuptake inhibitors). Many pain management specialists utilize this type of medication for chronic pain treatment particularly for people who live with constant debilitating chronic pain, as their serotonin system becomes depleted. This type of medication is good for both depression as well as improving pain management.

SSRIs like Prozac, Effexor, Lexapro, or Celexa, improve mood as well as help relieve pain, reduce fatigue and improve sleep problems. There have been reports about SSRIs being helpful for some types of neuropathic pain symptoms. Some studies also suggest that using an SSRI and a tricyclic antidepressant (such as amitriptyline) together may be more successful at breaking the cycle of pain, depression, and sleep problems caused by fibromyalgia than using just either one alone.

In addition, these three antidepressant medications can also be very helpful; Cymbalta and Effexor, which block the reuptake of serotonin and norepenepherine and Wellbutrin, which alters the levels of norepenepherine and dopamine. Cymbalta is a versatile medication that is FDA approved to treat depression and certain types of neuropathic pain. Norepenepherine, serotonin, and dopamine are neurotransmitters that not only affect depression but also pain management. Many pain management specialists recognize that combining different medications creates a synergistic effect for both pain management and improving depression.

The good news is that there are many different management and treatment options for depression. Try to remember that overcoming depression can take time and someone living with chronic pain and depression will need to stay strong and focused when faced with tough pain days. They will also need to reach out for support to keep them from becoming isolated. The important thing to remember is that overcoming depression is achievable with the right team and the right plan!

If you'd like to receive training for helping people with chronic pain and coexisting disorders, including addiction, I'm very excited to announce we are once again presenting my Addiction-Free Pain Management® Certification Training in Sacramento on November 11-13, 2010 this time in our new office space. To learn more about this and my other upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you're in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publicationspage and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Monday, June 7, 2010

Many people living with chronic pain with coexisting psychological disorders including addiction, are unwilling or unable to go into a structured treatment program. Sometimes this is due to not having quality programs in their immediate area. Other times it can be due to the financial commitment some of these inpatient or residential programs require. While for others it is not wanting to be stigmatized or pathologized (sick, bad etc.). This is where phone or cyber coaching can fit in.

Addiction-Free Pain Management® (APM)Coaching Program

The purpose of APM™ Relapse Prevention Coaching is to guide people who are living with chronic pain and may be struggling with pain medication issues to become active participants in their healing process. They will learn a strategic set of new pain management protocols that will help them to recover their health and regain their independence, thereby improving the quality of their life. Most importantly, participants will discover a light at the end of the long dark tunnel their life of pain has become.

With the assistance and the support of a Certified Coach, clients will experience the seven clinical processes that help them to quickly identify and manage high-risk situations that cause relapse. They will receive expert guidance in setting powerful recovery goals and implementing specific actions plans to facilitate their continued recovery.

The foundation of our Relapse Prevention Coaching Program is the evidence-based work and 40 years experience of Terence T. Gorski's Developmental Model of Recovery. As an Advanced Relapse Prevention Specialist and Director of Training and Consultation for the CENAPS® Corporation, my expertise in denial, relapse prevention and co-existing disorders underlie his biopsychosocial, multidisciplinary approach utilizing an ongoing continuum of care that incorporates strategic, cognitive-behavioral skill building exercises in conjunction with powerful solution-focused and strength-based coaching methodologies.

If people knew they could participate from anywhere using their phone and/or a computer, and that they could become active participants in their healing by participating in our coaching program, we feel confident that their feelings of helplessness and hopelessness would disappear.

Check out our Coaching Questionnaire which is the first step of deciding if you or someone you know is ready for APM or Relapse Prevention Coaching, or call Ellen at 916-575-9961f or a confidential interview.

If you'd like to receive training for helping people with chronic pain and coexisting disorders, including addiction, I'm very excited to announce we are presenting my Addiction-Free Pain Management® Certification Training in Sacramento on August 5-7, 2010. To learn more about this and my other upcoming trainings you can check out our Calendar page.

You can learn about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System.To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Tuesday, June 1, 2010

I believe it is important for people living with chronic pain to understand that sometimes what you most fear you actually create. When you live with chronic pain you hurt. Doing certain things can make you hurt worse. So you come to believe that these things will always cause you to hurt. In other words, you associate those things with pain. You believe that every time you do those things, you will have pain. Because you believe that you are going to hurt, you can actually activate the physiological pain system just by thinking about doing something that you believe will cause you to hurt. This is called anticipatory pain.

Once the physical pain system is activated, the anticipatory pain reaction can actually make your pain symptoms worse. Whenever you feel the pain, you interpret it in a way that makes it worse. You start thinking about the pain in a way that actually makes it worse. You tell yourself that the pain is "awful and terrible," and that "I can't handle the pain." You convince yourself that "it’s hopeless, I’ll always hurt, and there’s nothing I can do about it."

This way of thinking causes you to develop emotional reactions that further intensify or amplify the pain response. The increased perception of pain causes you to keep changing your behavior in ways that create even more unnecessary limitations and more emotional discomfort. This can make you feel trapped in a progressive cycle of disability.

If you'd like to receive training for helping people with chronic pain and coexisting disorders, including addiction, I'm very excited to announce we are presenting my Addiction-Free Pain Management® Certification Training in Sacramento on August 5-7, 2010. To learn more about this and my other upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you or a loved one is undergoing chronic pain management, especially if you're in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publicationspage and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Thursday, May 27, 2010

Neuropathic pain is a complex chronic pain state that is usually accompanied by tissue injury. With this type of pain, the nerve fibers themselves may be damaged, dysfunctional or injured. These damaged nerve fibers send erroneous signals to other pain centers in your brain. The impact of nerve fiber injury includes a change in nerve function both at the site of injury and areas around the injury.

According to the Neuropathic Pain Network, somewhere between five to twenty-three million people (that’s between 2 to 8 percent of our population) are living with neuropathic pain in the United States. Unfortunately, it is a syndrome that is often under-diagnosed and under-treated.

Some of the symptoms of neuropathic pain including shooting pain, burning pain, tingling, and numbness. An example of neuropathic allodynia—a non-harmful stimulus perceived as painful—is rough clothing rubbing on your skin which you feel as if it were sandpaper; another example would be someone shaking your hand in what is really a gentle grasp but you feel it as crushing or excruciating.

Another striking example of neuropathic pain is called phantom limb syndrome. This occurs when a limb like an arm or a leg has been removed because of illness or injury. The brain still receives (or perceives) pain messages from the nerves that originally carried impulses from the missing limb. These nerves now misfire and cause pain.

As anyone living with neuropathic pain knows the treatment can be frustrating and often ineffective. While acute short-term pain is usually easy to manage and most chronic pain management conditions can be treated effectively, neuropathic pain can be a major treatment challenge for both patients and their healthcare providers. Unfortunately, neuropathic pain often responds poorly to standard pain treatments and occasionally may get worse instead of better over time. For some people, it can lead to serious disability.

The capsaicin patch could be a much needed tool for many people experiencing neuropathic pain symptoms and find that other pain management medications (e.g., opiates or SSRI’s and SNRI’s) are not helping or have too many side effects. Of course medication management is only one component of an effective pain management treatment plan.

I believe that people also need to be developing nonpharmacological interventions as well as learning to better manage the psychological/emotional components of their pain. For those symptoms cognitive behavioral and rational emotive therapeutic interventions give the best outcomes.

If you'd like to receive training for helping people with chronic pain and coexisting disorders, including addiction, I'm very excited to announce we are presenting my Addiction-Free Pain Management® Certification Training in Sacramento on August 5-7, 2010. To learn more about this 3 day 20 hour training and my other upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you're in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publicationspage and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue ofChronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Wednesday, May 19, 2010

Two Antidotes for Denial:

1. Peaceful Acceptance and

2. Problem Solving with Authentic Action

Acceptance is a peaceful acknowledgement of the truth. If you can calmly face the problem, acknowledge the truth about what is going on, and accept that it is happening to you, you can then develop a way for handling the situation. The person who has accepted the truth of a serious problem has the ability to honestly affirm to themselves: "I have a serious problem! I am responsible for dealing with it! I'm willing to learn how!"

Problem Solving is a system for finding solutions to your problems. Effective problem solving systems involve identification and clarification of your problems, identifying and projecting the logical consequences of alternatives, deciding which alternative to use, taking action, and evaluating the outcome. By recognizing and accepting the problem and developing an effective problem solving plan, your need to use denial will go down because your ability to manage your problems will go up.

This was the reason I teamed up with Terry Gorski and Jennifer Messier to write the Denial Management Counseling (DMC) for Effective Pain Management Workbook that could be a helpful resource for some of you reading this Blog. I believe that learning to identify and manage denial is a necessary first step for people living with chronic pain who want to learn how to develop and implement an effective pain management plan.

The DMC/Pain Workbook is designed for people who have experienced significant problems related to living with chronic pain, but who honestly don’t believe—or don’t want to believe—that their decisions and behaviors are undermining what could be an effective pain management plan. It can be one important tool to help someone identify and learn to manage their inner saboteur.

If you'd like to receive training for helping people with chronic pain and coexisting disorders, including addiction, I'm very excited to announce we are presenting my Addiction-Free Pain Management® Certification Training in Sacramento on August 5-7, 2010. To learn more about this and my other upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people in chronic pain or are undergoing chronic pain management and have any resistance or denial and want to learn how to develop a plan for helping to identify and manage denial please go to our Publicationspage and check out my book the Denial Management Counseling for Effective Pain Management Workbook.To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Tuesday, May 11, 2010

According to researched published in Pain Physician Journal (2006), 90 percent of people in the US receiving treatment for pain management are prescribed opiate medication. Of that number 9 percent to 41 percent had opiate abuse/addiction problems. Unfotunately, this is not the only problem with prolonged use of opiates.

Neuroplasticity (variously referred to as brain plasticity or cortical plasticity or cortical re-mapping) refers to the changes that occur in the organization of the brain as a result of experience. A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location as a consequence of normal experience or brain damage/recovery.

According to research published in Annals of the New York Academy of Sciences 933:175-184 (2001) titled “Spinal Cord Neuroplasticity following Repeated Opioid Exposure and Its Relation to Pathological Pain;” convincing evidence has accumulated that indicates there are neuroplastic changes within the spinal cord in response to repeated exposure to opioids. Such neuroplastic changes occur at both cellular and intracellular levels. Since so many people living with chronic pain are using opiates these neuroplastic changes need to be better understood.

If you'd like to receive training for helping people with chronic pain and coexisting disorders, including addiction, I'm very excited to announce we are presenting my Addiction-Free Pain Management® Certification Training in Sacramento on August 5-7, 2010. To learn more about this and my other upcoming trainings you can check out our Calendar page.

You can learn about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System.To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To see an online overview of a Web-Based Delivery of Addiction-Free Pain Management® please go to this Link for a free demo.

About Me

Dr. Grinstead is the Director of Training and Consultation for the Gorski-CENAPS ® Corporation. He is also an author and internationally recognized expert in preventing relapse related to chronic pain disorders and is the developer of the Addiction-Free Pain Management® System (please visit www.addiction-free.com for more information).